Posts Tagged ‘disordered exercise’

Passion drives many athletes and outdoor enthusiasts here in Jackson Hole, Wyoming. Surrounded by rugged mountain ranges and access to raging rivers, this recreational Mecca is a sort of proving ground for athletes who want to push their limits skiing, rock climbing, boating, biking, running and more. There is a strong subculture here that sets a high bar for “normal” exercise.

Passions Can Become Problems

More than 20 years ago during my early years in Jackson a friend and I did a 24-mile day hike up in Grand Teton National Park, a major feat for us east coast transplants. We got an early start and crested the top of the divide feeling pretty good about our accomplishment until a couple of local friends came jogging up the trail and passed us wearing fanny packs with water. If you climb or ski something here someone has climbed or skied it faster, or as part of a multi-peak day, or they first biked from town, swam across a lake, and were heading down to reverse their route after passing you. Seriously.

This Uber-athlete mentality makes it difficult to define “excessive exercise.” Disordered eating patterns that often accompany problem exercise are also normalized here. Sometimes eating takes obvious disordered forms such as severely restricting all food intake or bingeing and purging food. Less obvious disordered eating can be adhering to rigid food rules such as “eating clean” or following any number of fad diets that are socially accepted. This does not mean anyone who is consciously eating well to improve health or athletic performance has an eating disorder but points to the difficulty in identifying problems in subcultures like ours where extreme behaviors are normalized.

A group of friends on a long backcountry ski tour together may have no idea one member of the group has not eaten for 12 hours because she “ate too much” yesterday. Or she needs to hike, skin and ski first to “earn” her next meal. Or she “feels too fat” to eat. Or the food available doesn’t meet her strict guidelines of acceptable food. And with the exercise itself, if someone works out despite illness or injury or never takes a rest day, she is badass, dedicated, someone to be admired.

Excessive exercise as a form of purging in Bulimia Nervosa was added to the DSM-5 (the manual that outlines criteria for a variety of mental illnesses including eating disorders) in June of 2013. Exercise has long been recognized as a problem in a variety of eating disorders but it was not previously defined as a form of purging in place of other purging behaviors such as self-induced vomiting.

Unfortunately, the general public health messages that encourage people to “move more and eat less” don’t acknowledge any downsides to either of these mandates. “Earning” meals or treat foods with exercise is commonly encouraged and the fine line between balancing calories and physical activity or obsessing about these habits is often blurred. Exercise habits can’t be adequately assessed based simply on the number of hours or days each week, the type of activity, or even the intensity, we must look at what drives the exercise.

Is it enjoyable?

What happens if you miss a day of working out?

Has exercise replaced time you spend doing other things you enjoy or time you spend with friends and family?

Do you fuel and hydrate to support your activities?

Do you feel better afterwards or do you just feel relief that you exercised?

All of these questions must be considered in the context of the whole person. An elite or professional athlete may have to train on days conditions are less than ideal and training can appear compulsive to an outside observer and a recreational athlete who sometimes overdoes it may not have a problem. The point is we need to know that despite all of the positive benefits associated with physical activity, exercise can have a dark side. People who exercise while malnourished and underweight can experience accelerated bone loss and exercising after food restriction or other forms of purging can cause dangerous electrolyte imbalances.

If you suspect someone you care about has no idea that their passion may have crossed a line into dangerous territory – seek support. NEDA has a free Coach and Athletic Trainer toolkit with ideas that may apply to recreational athletes who are not being coached. Also from the NEDA website are the following risk and protective factors for athletes that may be helpful to consider in the broader context of appropriate or “healthy” exercise.

Sports that focus on the individual rather than the entire team. For example: gymnastics, running, figure skating, dance or diving, versus teams sports such as basketball or soccer.

Endurance sports such as track and field/running, swimming.

Overvalued belief that lower body weight will improve performance.

Training for a sport since childhood or being an elite athlete.

Low self-esteem; family dysfunction (including parents who live through the success of their child in sport); families with eating disorders; chronic dieting; history of physical or sexual abuse; peer, family and cultural pressures to be thin, and other traumatic life experiences.

Coaches who focus primarily on success and performance rather than on the athlete as a whole person.

Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.